National Provider Identifier
Kristin Marie Provo, PT, DPT
Kristin Marie Provo, PT, DPT is listed in the NPPES registry with a primary specialty of Physical Therapist in Mount Morris, NY and a listed phone number of (585) 658-4023.
Profile Overview
- NPI
- 1275849895
- Provider Type
- Individual
- Primary Specialty
- Physical Therapist
- Enumeration Date
- August 19, 2010
- Last Updated
- December 22, 2023
Practice Location
- Kidstart
- 5871 Groveland Station RD
- Mount Morris, NY 14510-9767
Phone: (585) 658-4023
Specialties
- Physical Therapist (225100000X)
Full Record
- NPI
- 1275849895
- Entity Type
- Individual
- Last Name
- Provo
- First Name
- Kristin
- Middle Name
- Marie
- Credential
- PT, DPT
- Provider Other Last Name
- Bruce
- Provider Other First Name
- Kristin
- Provider Other Middle Name
- Marie
- Provider Other Credential Text
- PT, DPT
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- Kidstart
- Mailing Address Line 2
- 5871 Groveland Station RD
- Mailing City
- Mount Morris
- Mailing State
- NY
- Mailing ZIP Code
- 14510-9767
- Mailing Country
- US
- Mailing Phone
- (585) 658-4023
- Mailing Fax
- (585) 658-4066
- Practice Street Address
- Kidstart
- Practice Address Line 2
- 5871 Groveland Station RD
- Practice City
- Mount Morris
- Practice State
- NY
- Practice ZIP Code
- 14510-9767
- Practice Country
- US
- Practice Phone
- (585) 658-4023
- Practice Fax
- (585) 658-4066
- Enumeration Date
- August 19, 2010
- Last Updated
- December 22, 2023
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- December 19, 2023
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physical Therapist (225100000X)